Does Medicare Cover Colonoscopy?

Are you wondering, “does Medicare cover colonoscopy?” Here’s everything you need to know about whether or not Medicare will cover your colonoscopy.

Fifteen million colonoscopies take place in the USA every year. Screening colonoscopies are critical in diagnosing colon cancer early and providing effective treatment before the condition becomes life-threatening. Black Panther actor Chadwick Boseman recently died of colon cancer at the ripe young age of only 43.

So you know you should be having colonoscopies, but you are probably wondering, does medicare cover colonoscopy? Here is everything you need to know about Medicare and colonoscopies.

What Is a Colonoscopy?

A colonoscopy is an exam used to screen for abnormalities in the large intestines (colon) and rectum. Primarily doctors are looking for polyps or other kinds of abnormal tissue. 

Polyps are growths in the lining of the colon and rectum. Many polyps are not cancerous initially but can become cancerous over time. Polyps can be removed during the colonoscopy.

Does Medicare Cover Colonoscopy?

The short answer is yes. US health authorities aim to perform screening colonoscopies on 80% of people aged between 50 and 75 by the year 2024. To do this, Medicare has included screening colonoscopies in its coverage. 

While screening colonoscopies is covered by Medicare, there are other procedures and additional health services that may not be covered that patients need to be aware of. 

Screening Colonoscopies and Diagnostic Colonoscopies

Medicare will cover a screening colonoscopy under the condition that the doctor accepts the assignment. This means the doctor agrees to do the procedure at the standard medicare reimbursement rate. 

It is essential to distinguish between a screening colonoscopy and a diagnostic colonoscopy. If the doctor does not view or remove any polyps during the procedure, the colonoscopy is a screening colonoscopy, and the patient will not pay anything for the test.

If the doctor has to remove polyps during the procedure, the screening colonoscopy becomes a diagnostic colonoscopy. If this occurs, the patent will need to cover these out of pocket expenses:

  • A copayment if the doctor conducts the colonoscopy in a hospital
  • And 20% of the medicare-approved amount of the doctor’s fee

Furthermore, once a doctor has identified one or several polyps, the patient will be recommended to return for another colonoscopy sooner than the typical ten years. These colonoscopies will be diagnostic, and the patient will be required to cover the expenses above. 

Colonoscopy Frequency

Medicare will cover screening colonoscopies at the following intervals.

  • Once every ten years
  • Once every two years, for people at a higher risk of colorectal cancer, these are people with family or personal histories of colon cancer.

Medicare does not cover any additional screenings.

Additional Expenses

The Medicare enrollee may be responsible for additional costs. For a screening colonoscopy, about one-third of patients receive anesthesia. Coverage was expanded to include anesthesia costs in 2015, meaning patients are not charged a copayment.

For diagnostic colonoscopies, patients may be responsible for costs including:

  • Doctors services
  • Hospital services
  • Laboratory testing of polyps
  • Anesthesia services

This can make receiving a diagnostic colonoscopy financially challenging for some patients. However, the cost of colorectal cancer is much higher than preventative screening and saves lives.  

Getting A Colonoscopy

Getting a colonoscopy is unpleasant enough without having to wonder does medicare cover colonoscopy? With coverage, patients can have peace of mind that routine checks are covered and that they can screen for colon cancer without worry about affordability. For those looking for more coverage than provided by Medicare, check out the benefits of Medicare Advantage.

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